Dáil Éireann debate -
Tuesday, 22 Oct 2019

Vol. 988 No. 3

Acknowledgement and Apology to Women and Families affected by CervicalCheck Debacle: Statements

The Taoiseach

As Taoiseach, on behalf of the State, I apologise to the women and their loved ones who suffered from a litany of failures in how cervical screening in the country operated for many years. I do so having listened to many of those affected and do so guided by the Scally inquiry report.

Today we say "Sorry" to those whose lives were shattered. We say "Sorry" to those whose lives were destroyed and to those whose lives could have been different. We know that cancer screening programmes cannot detect all cancers, but we also know that many failures have taken place. We are sorry for the failures in clinical governance. We are sorry for the failures in leadership and management. We are sorry for the failure to tell the whole truth and to do so in a timely manner. We are sorry for the humiliation, disrespect and deceit, the false reassurance, the attempts by some to play down the seriousness of the debacle and inaccuracies and claims from others, all of which added to confusion and public concern.

We apologise to those who survived and still bear the scars, both physically and mentally, as do their families. We apologise to those who are here in our presence and to those watching from home who have always kept this matter to themselves. We apologise to those who have passed on and cannot be here. We acknowledge the failure that took place with CervicalCheck. I know that today's apology is too late for some who were affected and that for others, it will never be enough. Today's apology is offered to all of the people the State let down and to their families who also paid the price for those failings - a broken service, broken promises, broken lives, a debacle that left a country heartbroken, a system that was doomed to fail.

We apologise to our wives, daughters, sisters and mothers. We apologise to the men who lost the centre of their lives and who every day have to pick up the pieces - single fathers and grandparents. We apologise to the children who will always have a gaping hole in their lives. We apologise to all those who are grieving for what has been taken from them; the happy days that will never be. A State apology may not provide closure, but I hope it will help to heal.

I have met some of you and your families in recent weeks. I have heard your stories, told to me with dignity, courage and integrity, about families turned upside down; the grief of losing loved ones; the guilt of those who survived, thinking they were the lucky ones; those who have lost their jobs and careers, their ability to have children, and their feeling of self-worth; those who feel mutilated inside; and about those who feel they have robbed their partner out of the possibility of having a child, with a future stolen from them. A State apology will not repair all that has been broken or restore all that has been lost but we can make it count for something. Thanks to Dr. Scally's three reports into CervicalCheck, we have discovered many truths and now know many of the facts. There are some things that we will never know but we can act on what we know about. The Government has accepted all of the recommendations set out in Dr. Scally’s reports and all will be implemented.

In the words of Vicky Phelan, I too want something good to come out of all of this. Speaking as a doctor, as well as a politician, a brother and a son, I know the lessons we must learn. We need to build a different and much better culture in our health service, one that treats patients with respect and always tells the truth and which is never paternalistic, because the doctor does not always know best. We must share full information with our patients, admit mistakes and put the person first. There is no information about a patient that the patient should not know. No patient should ever feel stonewalled by the system. We should never fail to act out of fear of litigation or recrimination even if those fears are real. The involvement of patient advocates such as Stephen Teap, Lorraine Walsh and others has shaped and enhanced our response. We revised the open disclosure policy so that in future patients will have full knowledge about their care and treatment. They will be informed when things go wrong, will be met to discuss what happened, and will receive a sincere apology if an error was made while caring for them. Above all, patients will be treated with compassion and empathy.

The new patient safety Bill will provide for the mandatory reporting of serious reportable events and will establish a statutory duty of candour. We will soon establish a new independent patient safety council. The first task of that council will be to undertake a detailed review of the existing policies on open disclosure across the whole healthcare landscape. As a State, we aim to make cervical cancer a very rare disease. It is almost impossible to eradicate a disease but we can come very close. We are switching to primary HPV screening and Ireland will become one of the first countries in the world to adopt this new, more accurate screening test. We are also extending the ever-developing HPV vaccine to boys. We are educating and informing parents about the benefits of the vaccine. We are investing in better facilities in Ireland, such as a national cervical screening laboratory, in conjunction with the Coombe. This enhanced facility will take some time to develop but will provide a better balance between public and private provision of laboratory services to the cervical screening programme, always putting quality ahead of cost, and it will bring more testing back to Ireland.

I also want to recognise the staff of the HSE, of CervicalCheck in Limerick, and the people working in smear clinics, colposcopy clinics and outpatient departments across the country. They too got caught up in the system's failure. I know they are not individually to blame and have been working hard ever since to put things right. We need to restore confidence in screening. We need to listen to those who have suffered and learn from their stories so that we can find justice and truth. In July, this House established the CervicalCheck tribunal, a statutory tribunal to deal with the issue of liability in CervicalCheck cases. It will not be perfect but it will be quicker, with a dedicated judge and independent experts, and it will be less adversarial than court. Women will still have the right to go to court. Separately, we established an ex gratia compensation scheme for those affected by the non-disclosure of CervicalCheck, to provide financial compensation without the need to go to court. However, this was never about money. It was about accountability, discovering what happened and why, providing justice and finding peace. It was about making a meaningful acknowledgement of what happened and giving an assurance that this will not happen again to anyone else again. Sadly, as we have seen further errors in some laboratories since the publication of the Scally report, causing confusion and anxiety, I know we have more to do to restore confidence and we are determined to do so.

What happened to so many women and their families should not have happened. While every case was not negligence, every case was a lost opportunity for an earlier diagnosis and treatment. It was a failure of our health service and our State, its agencies, systems and its culture. We have found the truth and the facts and are making changes to put things right. We need to restore trust and rebuild relationships that have been severely damaged. On behalf of the Government and the State, I am sorry that all this happened and I apologise to all those hurt or wronged. We vow to make sure that it never happens to anyone else ever again.

Deputy Micheál Martin

On behalf of the Fianna Fáil Party, I strongly support and welcome the apology by the Government for what women and their families were put through as a result of the cervical cancer screening scandal. The incredible and avoidable stress that they and their families have had to endure, as well as too many serious delays in treatment, have quite rightly been a major concern for the Irish people since the first details of this scandal emerged. I wish to share my speaking time with Deputy Donnelly.

It took a very brave and determined woman, together with her family, to go to the High Court before the scandal was actually acknowledged and it has taken a series of damning independent reports before the full details were revealed. The facts of this scandal and the failings it exposed have posed a direct and urgent challenge to a vital part of our health system and those who oversee it. However, our first duty today must be to honour the fight of those affected in order to obtain information, accountability and, above all, change. They fought for themselves, but they also fought for the women of today and the years ahead who need a screening service and a system they can trust at one of their most vulnerable moments. This scandal has touched on many important issues relating to the oversight of our health services and, more fundamentally, how the rights of individuals can be too often ignored in the design, delivery and oversight of women's health services.

Screening services are one of the greatest advances of modern medicine. The ability to identify diseases in time for early and more effective treatment is now a fundamental part of helping people to live longer and healthier lives. In this case, the introduction of national screening for cervical cancer directly targeted one of the diseases most responsible for the early deaths of women. Let us never forget that this service has saved thousands of lives. No screening or diagnostic service in the world is without error. However, every patient who uses such a service has the right to know that everything possible has been done to reduce potential error and that they will be quickly and fully informed when those errors are spotted.

As the High Court heard and as the Scally and MacCraith reports showed in detail, hundreds of women were badly let down on these fundamental points. Since the system believed in the value of its work and because of a failure to put the patients' interests at the centre of every decision, vital information was withheld, appalling errors were made and it took immense legal, public and political pressure for action to be taken. As the reports demonstrated, there was an aversion to open and full disclosure. Multiple examples were exposed of what Professor MacCraith described as women being frustrated in their search for results and clarifying information. They were given incorrect information, often after another serious delay and for many, the information they were given was still inaccurate. The paternalistic approach of deciding what women could be allowed to know about their own health was demonstrated at important moments, with vital results often only supplied to doctors with no intention to inform the women involved.

The reports also pointed to the central lack of proper corporate governance within the HSE. The replacement of the HSE's independent board by a system that directly reported into the Minister's office was an enormous error by the Government and underpinned a culture where there was no one focusing on general oversight. Dr. Scally particularly pointed to the need to restore this essential governance layer and for the voices of patients to be included at this level. The Government's decision to reverse its abolition of the HSE board is welcome and we hope it will become the driving force for reform, which is so badly needed.

The series of recommendations made in the Scally and MacCraith reports are detailed and there appears to have been progress in important areas. However, the history of the handling of this scandal and of other scandals in recent years means nothing can be taken for granted and pressure must be maintained so the reports are implemented in full. Errors were clearly made in that response and lessons will have to be learned.

I would like to remind the Taoiseach and the Minister for Health, Deputy Harris, that in the full spirit of this apology, we need to bear in mind the sense of grievance one whistleblower, Ms Sharon Butler Hughes, still has about how she was treated. She feels her integrity was wrongly impugned. She did some important work for the public good and service. I ask the Minister please to meet Sharon Butler Hughes without precondition-----

Deputy Simon Harris

Yes.

Deputy Micheál Martin

-----because the letter that issued to her put preconditions on such a meeting and in the spirit of this apology I would like to see that happen.

In the future work of this House, we must make sure we honour the struggle of those who worked to get to the truth and demand reform. We cannot let the programme of change for the planning, delivery and oversight of screening services become yet another area where early publicity is followed by a failure to deliver. This apology by the Government is an important step, but the true measure of it will be seen in the action which is taken today and in the months and years ahead. It will particularly be seen in the judicial system, where the State must follow through on the spirit of this apology in not being adversarial. An adversarial judicial system has become the essential mechanism for the cover-up of scandals of this kind. Never again can that happen.

It is about eight years ago since Ms Vicky Phelan was first diagnosed and it took a long time to get to the High Court and to get the situation revealed. It is about a year since the hearse of Emma Mhic Mhathúna passed by the gates of Leinster House, as part of a premeditated decision by Emma to remind us all of the impact of this scandal, and to remind us of our essential duty and obligation to make sure nothing like this ever happens again. We thank them and all the women involved for their dogged determination in ensuring change and in providing a pathway for the future well-being of women in this country.

Deputy Stephen Donnelly

I want to acknowledge the women and their families who have travelled to Dáil Éireann and who are with us today. I also want to acknowledge the many women and their families who are watching this apology at home. Today's apology is important and welcome. A formal State apology is a serious thing. It is an acknowledgement the State has caused or has been complicit in causing, the most serious hurt to people, and it is undeniable many thousands of women across Ireland have been treated appallingly in the last year and a half.

Every woman should have been told of the results of previous audits of their tests. No woman should have had to battle both the laboratories and her own State in court. No woman should have been asked by her own State to sign a non-disclosure agreement. Women and their families should have had access to supports quickly once this was uncovered. Some 80,000 women should not have had to wait up to nine months to receive their test results and many thousands more should not have had to go for retests. No woman should have been shut out of the public healthcare system because, in desperation, she went and paid privately for a test. When that happened, the HSE should not have apologised for any "confusion" caused: it should have been very frank, very open and very apologetic. It should not have taken the work of one woman to uncover the serious issue of many test results not being issued to either the women nor to their GPs. Preconditions should not have been given to any woman about what she could and could not discuss with Government when they met.

Dr. Scally's report into the governance failings was comprehensive. It is good to see and I acknowledge the progress being made on his recommendations. However, as the Taoiseach has said, there is far more that needs to be done and I agree with that. The HPV test will save lives and it was meant to be in place last September. We must all work together to get it in place as quickly as possible. Many women who face delays seeking smear tests are now facing delays in their follow-up specialist care and we must all work together to bring those waiting lists down to zero.

It is essential these issues are resolved, that public confidence is rebuilt, that as many women as possible engage in the screening service and that men engage in the other screening services, because they save lives every day. It is thanks to the service of women and their families, some of whom are with us today, and it is thanks to their fight, their refusal to be silent, their bravery and their extraordinary perseverance that we are here today and that we have identified many of the failings. We must and can work together to fix those failings, to make sure we have the best and most effective screening services on Earth, and that all patients, women and their families are treated at all times with dignity, respect and openness.

Deputy Mary Lou McDonald

Before I begin, I want to acknowledge the women and their families who join us today. The Taoiseach's apology is most welcome. It is important the apology not only relates to the initial failures, but also to how women were treated in the wake of this scandal. Women and their families were dragged through the courts to access their vital medical information. Women had to fight to access information on assistance payments. The initial investigations were slow and struggled to gain the confidence of the women affected. Unfortunately, as the Taoiseach has acknowledged, delay and obstruction were the overriding themes of the response to this catastrophe. Mistakes were made again and again, as more women received incorrect results. Labs were added to the CervicalCheck programme without the proper checks being conducted.

I hope I am wrong but unfortunately it seems that some of the lessons of this crisis have still gone unlearned, because beyond this welcome apology, Government must fix the system. Dr. Gabriel Scally called this apology momentous, stating that: “The three things that really matter to people when things really go wrong badly in the medical system are for someone to tell them the truth, what went wrong, why it went wrong; secondly to say sorry and to really mean that, and from someone with some skin in the game; and the third is to say how it is going to be avoided in the future.” This means that in addition to this apology, there needs to be real reform of the screening programme, because screening saves lives. We must see the recommendations of the Scally and MacCraith reports implemented because we can give apologies here with words, but words are hollow without the actions to back them up. We can say that lessons have been learned from this and that this will never happen again, but without putting in place the recommendations of the Scally and MacCraith reports, this could happen again.

A real and tangible apology consists of words and actions. Let us say honestly that because of what happened and in the memory of those who are no longer here, real change has been made, our services are better and this will never happen again. Central to ensuring this is the repatriation of the smear testing process to Ireland. This was recommendation No. 7 of the MacCraith report. It is imperative that a plan, along with funding, is put in place to do that.

It is clear that outsourcing played a part in this scandal and in the further mistakes that were made as regards delays in tests and the issuing of results. We know that this cannot be achieved overnight, but we need to work towards it because we have to fix the system. We have to ensure that women can enjoy absolute confidence in the screening processes on which we rely. Fixing anything in the health service means funding, as the Taoiseach knows. His words today need to be followed with actions and those actions need to be backed up by funding.

It was disappointing that in this year's budget no specific funding allocation was allotted to the CervicalCheck programme. This needs to change. The programme needs additional funding to ensure it can change and to implement the recommendations of the MacCraith and Scally reports. I hope, after this moment of apology, that in the coming weeks additional funding can be put forward for the CervicalCheck programme.

We also need to see the implementation of the patient safety Bill. This will provide for mandatory open disclosure of serious reportable patient safety incidents and notification of reportable incidents as well as other changes. The general scheme of the Bill was published in July 2018 but we are still awaiting pre-legislative scrutiny and holding out for its implementation. It is a matter of utmost urgency that the Bill be progressed and that we have full open disclosure.

In the summer of 2018, Emma Mhic Mhathúna spoke outside the gates of the Dáil. She stood with her young children at her side, who were facing the unbearable reality that they would lose their beautiful mother so early in life. With the mic in her hand, Emma was a force a nature – sharp, witty, funny and utterly unbroken. One line from her speech sticks in my mind to this day. I recall that Emma said; "I am not going to die and leave this country in unsafe hands." I stood in awe of this young mother fighting for her life and yet still having the courage and determination to speak out for others. She was grace itself, a wonderful person whose tomorrows were stolen from her. She was a beloved mother, daughter, sister and friend whose life was cut short.

I acknowledge there were many other Emmas, other women whose names we might never read in our newspapers but whose families too now live with the sorrowful reality of the empty chair. Beyond the headlines and the heat of the political crisis, Stephen Teap gave an insight into life without his wife, Irene. It is the simplicity of what he had to say that revealed the utter heartbreak. Stephen said; "For instance, I look at Noah [one of his boys] and I ask myself: do I start him in school in September or do I wait until next year? Who do I bounce that thought off? You end up discussing it with relatives and friends and it's like all decisions then are just you and you alone." Every parent inside and outside the House can relate to the loneliness of those words. This is the scale of the devastation. This is the depth of the loss. This is the CervicalCheck scandal. We can never lose sight of the human cost of the failures and we should never ever underestimate it. I know we do not.

We also should never forget that if it was not for Vicky Phelan revealing her personal agony in such a very public way that all of this agony may have been borne very privately. Vicky Phelan did not stay silent. Vicky spoke up. What dignity and what bravery. She is owed an immense debt of gratitude. Thank you, Vicky.

As I said, the State’s apology is welcome but the Taoiseach's words must mark real and tangible change. It is our responsibility now to honour the memory of women such as Emma and Irene by fixing our system. This is the very best thing we can do for all of the women affected by the CervicalCheck scandal and for all of the women, girls, men and boys of Ireland.

Deputy Alan Kelly

When Vicky Phelan stood outside the High Court in April last year, following her decision not to sign a confidentiality agreement regarding her case, she changed Irish healthcare provision forever. Her campaign for justice since then has been one of the most courageous any of us has ever seen and certainly the most courageous I have ever seen. When she, along with her fellow campaigner, Stephen Teap, attended the Committee of Public Accounts a few weeks later, they opened a scandal to us that was unprecedented, complex and deeply troubling. I swore to them that day walking back to their taxi that I would do all I could to help them and I hope I have honoured that.

We, as a State, are today acknowledging that we let down the women of Ireland. We let down the women affected by the cervical cancer scandal and we let down their families. It is a watershed moment. I thank the Taoiseach for listening to the continuous requests that I and many others made for this day to happen and for meeting the 221+ group and their patient representatives on a number of occasions recently. It also helped him to understand that this day was necessary.

I acknowledge all of the women in the Gallery and their families. I also acknowledge all of the young people who will look back on what we are saying today. They have been affected by it but they are that little bit too young to fully understand it. I am particularly thinking of Noah and Oscar Teap. This record will be there for them and many other young people who have been affected. It will record the mistakes that deprived many of them of a loved one.

An apology today will not bring back any of the women who have passed on, including Emma Mhic Mhathúna, change the terminal diagnoses others have, prevent the fact that some women, such as Lorraine Walsh, cannot have children, or make up for many of the medical complaints from which many of the women continue to suffer. What it is though, is the beginning of a healing process. Finally, we have a proper informed official acknowledgement of the wrongdoings that happened.

Collectively, we have all learned so much since Vicky spoke outside the High Court. We have had the Scally and MacCraith reports. They have shed so much light on what happened. They also raised ongoing questions regarding the Department of Health, the HSE, healthcare professionals and many others. I and others will continue to pursue those questions.

We in the Chamber also have questions to answer but they are certainly for another day. However, one thing is very clear: The decision to outsource the laboratory work many years ago was the wrong one. In fairness to some Deputies, one of whom is sitting beside me and one a few seats away from me, they questioned this and pointed it out at that time. The laboratories were not fine. The quality assurance that was necessary was not in place, the contracts were not managed appropriately and the accreditation in some cases was done retrospectively. These are the facts. It was not acceptable. I do not believe we have found out everything about some aspects but perhaps with the passage of time, we will.

Today, I am hugely thinking of another lady, Ruth Morrissey, who had to take on the State to get justice. She spent over two weeks in total in the High Court only to have the judgment appealed again. Today, I stand in solidarity with her. The Taoiseach said no woman would have to go through what Vicky Phelan went through and no woman would have to face the adversarial setting of the High Court given what had happened to them.

It was an error by the Taoiseach but I accept that he has subsequently acknowledged that and it is important that he did. The way Ruth Morrissey is being treated by the State is not something that I accept, however, and I am thinking of her and her family today.

I want particularly to acknowledge the patient advocates who have worked so hard on behalf of the 221+ support group. I acknowledge Mr. Stephen Teap, who lost his beautiful wife Irene, and Lorraine Walsh, who lost the opportunity to have children. I also acknowledge the amazing Vicky Phelan. The work and advocacy they have done has been frankly incredible. Three finer, more decent and caring people I have never met. They deserve to be respected by us all and particularly by the Department of Health in a way that has not happened to date. This must change and they, along with other patient advocates, deserve to be acknowledged and if we are going to have patient advocates across many different settings, we also need to remunerate them.

This long battle has had some good results: better awareness of screening, a developing understanding among the public that screening is not diagnostic and the introduction of HPV screening. We, in this Chamber, need to row in behind the HPV vaccine, not just for its health benefits but also to acknowledge and honour the work of Laura Brennan and others.

The provision of HPV vaccinations in schools for boys to help create herd immunity is another important step. We can actually get rid of cervical cancer in this country. We can get it down to the minimum level as has been done in other countries.

We have also learned throughout this process to question health professionals in a way that simply did not happen before, even when it needed to. People are taking control of their healthcare and that is good. Of course, we are in the process of ensuring that open disclosure becomes ingrained in our healthcare provision, which it always should have been.

However, there are many challenges ahead. The implementation of all the Scally recommendations must happen quickly. The audit of cervical screening has stopped and must recommence from the day the previous one ceased. I have never got confirmation that will happen and I ask the Taoiseach to confirm it. Audits are good things and the recommenced audit must start from the day after the previous one stopped.

We also need to provide an optional, low-cost vaccination programme for adults. Dr. Doireann O'Leary, a general practitioner from Cork, has pointed out there is growing evidence that the vaccine is effective past adolescence and beyond the age of 26.

The review by the Royal College of Obstetricians and Gynaecologists, RCOG, also needs to be completed. I am making a clear point to the Taoiseach today. The fact that the review is behind schedule and that there are issues with validating the data is not acceptable. The State must get this right and cannot mess it up. At present, I am not supremely confident the State will not mess it up and that cannot happen. When did an independent review by RCOG have to be revalidated by the HSE? This is something I hope the Taoiseach and his Minister will prioritise.

Today has been a long-awaited day for the women of Ireland, particularly those at the centre of this scandal. It is a critically important day for all of the people in the Gallery who have been affected. What has happened to these women and their families over the past two years has been a black mark on our State's history. If the right steps are now taken, many of which have been outlined here today, it will mean we never allow such a black mark to happen again. I have talked to many of the people who are in the Gallery today and that is the true legacy that they want from today's apology. They want us to have a screening programme of which we can be proud, one that is open with patients and tells them everything, gives them the best care and looks after them as citizens of our State. We, collectively, must do that and if we do, that will be the ultimate impact of this apology for all of those watching from the Gallery and for all those who are watching these proceedings now and in the future.

Deputy Bríd Smith

I am sharing time with Deputy Coppinger. Like others, I warmly welcome the 221+ group and their families to the Gallery today and we should all be extremely proud of the calibre of women in this country and the courage they have had in fighting this terrible battle and tragedy.

One cannot help but notice there was a familiar ring to the apology although it was heartfelt from the Taoiseach and the Ministers involved. It is, once again, an apology to the women of this country whose lives have been unutterably altered by the actions and inactions of this State. While I am happy for the 221+ group, their families and the many others outside these Houses who are receiving this apology, I question what it actually means and the lessons and changes in policy that led to this tragedy.

I want to start by making what seems an obligatory statement, particularly for a woman in this Chamber. I support the screening programme fully. As a woman, I want to emphasise the importance of not undermining the national CervicalCheck screening programme. I support the programme and know too well that it is vital for women but I will not take lectures or mansplaining from Ministers or officials who try to patiently explain to me the difference between a screening service and a diagnostic service, that screening services have limitations and all of them have statistically proven numbers of misread or false negative slides among the reads. I know that, as do the women here and many of the women in Ireland. We also know all too well that we must question what today's apology is for. It is for treatment and non-disclosure, which is good but the apology would sit better with all of us in this country if we did not know that, in the near future, the Taoiseach, his Cabinet and the State will take the finest legal minds to a courtroom to argue against Ruth Morrissey in an effort to have a decision overturned that this State ultimately bears responsibility for the catastrophic errors in the laboratories in her case. The State is responsible.

Today's apology should be for the decision taken in 2008 by the then Government, and reiterated by Ministers of Health since, including the now Senator Reilly, the now Taoiseach and the current Minister, Deputy Harris, to continue the outsourcing and privatisation of the screening service. The State was responsible when it did not check whether the laboratories to which it contracted out the services were ISO accredited. The State was responsible when it made cheaper costs the chief criteria in awarding contracts to those outside laboratories and when it did not bother checking the condition and volume of work of screeners in the laboratories to which the service had been contracted. It is incredible that, to this day, the State has failed to investigate what happened in those laboratories when catastrophic errors were made in reading the slides.

For two years, I have asked for a breakdown of the laboratories involved in the misread slides and have been told it is complex, not straightforward, and a breakdown of these misread slides from the laboratories would not capture the full nuance of the issue. I have been told that the laboratories' standards and practices were beyond reproach. We have been told repeatedly by the Minister and the HSE that there is nothing to see, that all laboratories make errors and the errors that were made were statistically in line with what might be expected. Professor Scally was and is invoked to confirm that standards and practices in private laboratories are not the issue. Why, then, is the Taoiseach so assured by the good Professor Scally when the State specifically required him not to look at the medical records or slides of the 221 women? The Scally report never looked at the errors that have so far left 22 women dead with, sadly, more to follow. Scientists have been paraded out to confirm that we just do not understand the complexities and limitations of the screening but we now have the laboratory audit of the 221 women and 354 slides. We can now have some light thrown on these narratives. What do these statistics and figures show? One public laboratory, with cytologists and technicians trained here in Ireland to standards over which we had oversight, which were publicly funded and run not for profit, had an error rate of misread slides that was statistically a fraction of that found in Quest Diagnostics and CPL. The error rate for Quest in Illinois was five times that of the Coombe. The error rate for Quest in Teterboro was three times that of the Coombe. The error rate for CPL in Texas was seven times that of the Coombe and even the error rate for CPL in Dublin was five times that of the Coombe. It is incredible to say that, in every abattoir and meat factory in this country, an inspector sits there full time to oversee as cattle are slaughtered and meat is rendered to ensure that standards in end products are adhered to.

But for almost ten years we contracted out work to private laboratories because they were cheaper than our own public service and we did not think to monitor or have oversight of the quality and standard of the work.

I would hugely welcome this apology, and it would sit better, if the Government would cease to pursue Ruth Morrissey and reopen the audit for all women. My secretary's best friend is currently privately paying for an audit of her slides because she has been diagnosed with terminal cancer. Her community in Lucan is fundraising so she can pay that. There is a huge limitation to what has gone on and ending the review has unfortunately not stopped the addition of more cases of women who will face this trauma in the months and years to come. I welcome the apology, as I will welcome the next apology from the next Taoiseach or Minister when they finally apologise for the outsourcing of the service, which has dearly cost lives and created tremendous pain for thousands of families throughout the country.

Deputy Ruth Coppinger

I welcome the women, men and families who have come to the House today. I realise that, for them, it must be at least somewhat of an important step that there would be a formal State apology. It is an apology in words but is it an apology in deeds? We continue to outsource a vital health service and still women are being pursued by the State through the courts. Those two vital issues have not been changed one iota by the Government. Women are still not believed or assisted after all they have had to go through. The rights of the companies that profited from the issue continue to be placed before the rights of women in this country. What does it say that during this crisis, a group called Women's Lives Matter sprang up throughout the country? Is it not something else that women have to set up a group to tell the country their lives matter? That is exactly what has happened. Women's health, as we know, has been second place and second class in this country for a long time. The lack of communication during this crisis and the finding by Dr. Scally of medical misogyny constituted the Ireland of old, where male doctors often knew best and women were not consulted about their own healthcare.

The repeal the eighth campaign, the marriage equality campaign and the action of women in this campaign are positive developments in this country because they are a statement of the unwillingness of those who are being discriminated against to accept it any longer. One of the main slogans in the repeal campaign was, "Our bodies, our choice", which has been repeated thousands of times in recent years. So many spoke about the issue of not being heard or consulted about their own lives, health and future, and here we are again in the case of the women in question.

This is not unique to Ireland. Gender discrimination is an international feature of medicine. In the US, for example, there are 96 health schools but only nine run what are called women's health courses. There are many international statistics on the matter. In Ireland, such discrimination is particularly pronounced, given that there is a strongly patriarchal society, but moreover, the women in question have been victims of capitalism. A decision to outsource vital public screening was taken in the House by Fianna Fáil. While I do not know if Fine Gael voted for it at the time, it nonetheless carried it through. Others, including the former Socialist Party Deputy, Mr. Joe Higgins, spoke out against it at the time. The result, according to Dr. Scally, was that cost became more important than quality, while quality dropped as a weighting factor from 25% in 2008 to 15% in 2012. Price increased as a factor to 40% of the consideration for tendering in 2012. The outsourcing to laboratories thousands of miles away, whose work practices the Government is not privy to, has been the result. If the Government really is sorry, it should stop the outsourcing and commit to providing vital women's health and other health screening programmes through the public health service, and stop pursuing women in the courts.

Deputy Catherine Connolly

Fáiltím roimh an deis páirt a ghlacadh sa díospóireacht seo.

I accept the apology, which was the right thing to do, but for it to mean something, we will need action. Earlier, I raised the issue of the public hospital in Galway. Last week, Caranua appeared before the Committee of Public Accounts, of which I am a member. In 1999, the then Government made an apology to those who had attended residential institutions. When Caranua appeared before us, it was a perfect example of an institution having become far more important than the people it was there to serve.

Apologies can be given. They are very important. It is what the women in question deserve, but action is also necessary. I regret that within the Taoiseach's statement, of which I do not have a copy, I did not hear the Government take responsibility for the mistakes made by each Government during the debacle. In the chapter of his report entitled Women's Health, Dr. Scally states:

One key point that surfaced on several occasions was that most of the doctors involved in the disclosure (or non-disclosure) process were male. This, and the general way in which they felt they had been treated, led the women to develop concerns that the attitudes and lack of openness were accounted for by paternalism in the healthcare system.

The culture of paternalism and "we know best" has been mentioned but there are many further serious issues with decisions made by Government after Government. On the same page, Dr. Scally states, "There was a period when women’s health was taken very seriously." Can the Government imagine that? It should be grateful for that. He does not go on to say it is taken seriously now but states:

In 1997 the then Health Minister established The Women’s Health Council (WHC) with a remit to advise the Minister ... It had a comprehensive list of functions ...

That was then. Over the period CervicalCheck was in operation, I sat on a health forum in Galway. We knew then that the wrong decisions were being made by the then Minister for Health and Children, Ms Mary Harney, and her colleagues in respect of the matter. It simply should not have been done. More important, the people involved in the laboratories appealed to us and begged us not to allow it to happen but still it went ahead, in a manner whereby women's lives did not matter but the cost did. That is the underlying theme of the issue, namely, that women's lives were incidental to the cost, which was uppermost at all times.

A few passages of the report are worth highlighting. I have read all three reports, the first of which was minimal. It was followed by an interim report and then the final, detailed report by Dr. Scally. What strikes me as I read his report is that if we let him continue to investigate, he will uncover more issues. When we gave him free rein to return to his inquiry, he discovered there were laboratories in Honolulu and many other places. The more he searched, the more he discovered, which is interesting. Where do we stop Dr. Scally in his uncovering of issues about which the HSE and the Government knew nothing? The system in place was not perfect but, gradually, Government after Government made decisions including, as has been mentioned, abolishing the health boards, the Eastern Regional Health Authority and the independent board of directors.

We are told by Dr. Scally that from 2010, CervicalCheck did not have an accountable senior person responsible for the delivery of the programme. That is a Government decision. Staff recounted how the bank guarantee occurred three days after CervicalCheck was launched nationally in September 2008. As the financial crisis contributed to an economic recession, public sector programmes and organisations saw a reduction in the level of resources afforded to them, with CervicalCheck no different. As its budget was reduced, CervicalCheck struggled to replace departed staff adequately. Such decisions were made at Government level.

I turn to the chapter on CervicalCheck within the HSE governance system. Dr. Scally states that screening was downgraded, having been absorbed into the HSE, and staff felt they had little influence within the HSE as a whole.

In 2017, there was an appreciation at the top level of the HSE that not all was well. There were several findings and then a number of recommendations. The report made a series of eight recommendations. I do not have time to read them out but they are outlined on page 33 of Scally's report. Surprise surprise, nobody knows what happened to those recommendations but they certainly do not seem to have been implemented.

The board was dissolved, which meant the removal of an external, independent input into the running of the Health Service Executive at the highest level. The Scally report concluded what we really all knew, at great cost in deaths, suffering and the mental and physical health of the women. It confirmed the failure of CervicalCheck to tell women. We knew it afterwards. The crisis centred on the failure of CervicalCheck to tell women about their own medical information and disclose to them the results of a retrospective audit of their screening history carried out after they had been diagnosed with cervical cancer. A paternalistic milieu, a "We know best" attitude and economic decisions made by Government after Government led to this.

When giving an apology, it is extremely important to put the apology in context. It is important to listen as well. We have only a short time. We on this side of the Dáil have repeatedly been dismissed for being left and radical. I have been quoting Dr. Scally and the staff who worked for CervicalCheck throughout. I have listened to the women. When the Taoiseach gives an apology, I ask him to please put it in context and tell us what he will change. He should tell us how many of the 50 recommendations have been implemented. Following publication of the MacCraith report, will the Taoiseach tell us when the outsourcing is going to stop? That is the kernel of this debacle, along with the milieu and the culture. When will that stop?

On the role of the State Claims Agency, I note Ms Ruth Morrissey has been mentioned. Some clarity on that would be very helpful. Finally, I wish to raise a serious issue that shows the system is not functioning in an open and accountable way. None of this would have surfaced without the bravery of the women concerned, particularly Ms Vicky Phelan, who refused to sign a non-disclosure document. All of us would understand if she had done so, given the pressure she was under. She did not succumb to that pressure and neither did the other women. These are just some of the key issues in this debacle. With the Taoiseach's apology, let us hear context, practical recommendations and steps towards taking this vital service back. Let us look back to when women's health was theoretically important, in 1997. It is now 2019. Let us make women's health important.

Deputy Michael Harty

A formal State apology is a solemn occasion. It is very important and very welcome. It is essential that this apology is made and I thank the Taoiseach for it. It is important not only to the group of 221, but to all women who have been affected by the cervical screening scandal; those who have had their anxiety and concerns raised and those who have waited months for delayed results. This is of course a controversy which has particularly affected women, but it has also affected their partners and families, particularly the families of those who have died as a result of cervical cancer.

However, several issues have been raised in this controversy. It is very important to state that CervicalCheck has been a successful screening programme. It has saved lives. There has been a 7% year-on-year reduction in the incidence of cervical cancer and 50,000 precancerous changes have been identified since the programme was introduced in 2008. In fact, it was introduced in the mid-west in 2001. That may be cold comfort to those who have suffered because of the deficiencies of cervical screening but it is very important to recognise that this screening programme has essentially been successful, albeit not in all cases. Dr. Gabriel Scally made 50 recommendations in his first report. He identified flaws in the system. Every screening system needs to be constantly reviewed. The flaws he identified included a need for more oversight of the scheme, particularly expert international oversight, as well as experienced expertise in public health, colposcopy and communications. Every scheme can be improved, and unfortunately it took legal action to bring the deficiencies in this scheme to the fore. There have been failures in management, organisation and communication. If Dr. Scally's recommendations are carried out, they will all be addressed. Of particular importance was the placement of patient advocates on various committees in order that the patient's voice could be heard. That is extremely important.

It is important that we welcome this. Unfortunately, we need to welcome those who have suffered from cervical screening to the Gallery today. We should recognise their persistence in pursuing this issue. We as politicians have let them down but we have also striven to repair the damage of this scandal. It is important that we continue to improve this screening programme.

It is important to say that this is not a diagnostic test but a screening test. There are flaws in all screening tests and all tests will fail to pick some people up. That does not mean the failure to pick them up is in any way negligent. It is just an inherent problem with the scheme. However, there are some issues which need to be addressed. One of those is open disclosure. The withholding of information from any patient is wrong. We understand that. We are still waiting for the patient safety Bill to be brought before this House. It is extremely important that open disclosure is a part of the culture of our health service. It is the fundamental issue which underlies this scandal. The fact that an audit was introduced was extremely important. It was the correct action to take. Unfortunately, the closure of that audit loop was the failure of this cervical screening programme.

Dr. Gabriel Scally states it was "deeply contradictory and unsatisfactory" that the HSE had a policy of open disclosure but that policy was not implemented in this case. It is very important that when controversies like this arise, recourse to the courts should be the recourse of last resort. It should not be the recourse of first resort. Unfortunately, that is the case where people feel they can only go to the courts to get satisfaction. Open disclosure will satisfy many people in regard to wrongs they feel have been perpetrated against them by the health service.

There is another issue around absolute confidence. Cervical cytology is not a binary "Yes" or "No" question. It involves a matter of judgment about which it is difficult to be absolute. Screening cannot be absolute. In that context, a programme has built-in safeguards which will minimise missed cases but it cannot eliminate them completely. This is true of every screening programme. A missed case does not necessarily mean negligence was involved. It is extremely important that we move to a much more accurate test, that is, the HPV screening test. That will allow us to repatriate our screening to Ireland, where it should be. I am aware of no country in the world that outsources screening as we do. It is extremely important that HPV screening is introduced as rapidly as possible to allow us to look after our own screening. We will have much more control over the governance of such a scheme.

I am glad the Taoiseach mentioned the pressures that front-line staff in CervicalCheck were under. They were under severe pressure and are still under severe pressure in dealing with this fallout.

They have had to deal with the real and legitimate anxieties of women and been under extreme pressure to do so. It has affected their health. People have taken early retirement and left their jobs because they came under so much pressure over screening. The backlog in producing reports on smear tests arose from a political decision, whether right or wrong, to offer an out-of-cycle smear test as reassurance. It provided no reassurance and only increased women's anxieties. It should be highlighted that political decisions taken without recourse to thoughtful medical advice can have far-reaching consequences. It led to the anxiety over cervical cancer screening that has built up during the year.

Deputy Danny Healy-Rae

I welcome all those in the Visitors Gallery who have been affected by this sad debacle. I thank the Taoiseach for apologising on behalf of the Government for the failures of the State and the health system which let down so many women, with their husbands, partners, children, parents, grandparents and siblings. I especially thank two women, Emma Mhic Mhathúna who has departed and Vicky Phelan who did so much to highlight the terrible wrong done to so many women. I hope this very public apology will in some way ensure something like this will never be allowed to happen again. When people get sick, they should receive the very best available care from the health service, but it is clear that this did not happen for many. That must change from now on. What happened to so many women and their families is very sad. It need not and should not have happened. I appeal to the Taoiseach, the Minister for Health and the rest of the Government. They are the people on whom we depend to ensure the health service provides the required care for people when they get sick. When people are sick and vulnerable, the health service needs to kick into action and take care of them. It is clear that many aspects of the health service are letting people down and they have been let down. Emma Mhic Mhathúna who lived in Ballyferriter was let down, as were Vicky Phelan and so many others whose names I cannot remember. In many other aspects of the health service people are being let down. As Deputies, legislators and public representatives, with the Government, we need to ensure things like this will never happen again because when people are sick, that is the time they need care and are depending on us. I appeal to the Government to ensure nothing like this will ever be allowed to happen again.

Deputy Catherine Murphy

Like others, I welcome today's apology and the acknowledgement of the hurt and, in some cases, devastation suffered by women and their families as a result of the CervicalCheck crisis. This is not a happy day; it is a solemn and sad day for those in the Visitors Gallery. I know that recognition for the wrongs done and an apology for them are important landmarks for those so directly affected. However, it cannot be the be-all and end-all. An apology must name what went wrong. For an apology to be true, it must give an assurance that it will not happen again.

We have previously heard in this Chamber very encouraging words issued to women and their families, not least when the Taoiseach replied to me during Leaders' Questions to say none of the women would need to enter a courtroom to get justice. It was an error to give that assurance because the State was not the sole party involved. We need to reflect on these things when they happen in order that those errors will not be repeated in other circumstances. The court cases took place within months of those promises being made and people wondered what was happening.

Members of the 221+ group constantly contacted me to say it was like pulling teeth in trying to get answers and a satisfactory outcome. They had been promised that an ex gratia payment and package with some healthcare benefits would be forthcoming by Christmas 2018, yet it was May 2019 before they even received forms to complete. They were very upset and hurt about being presented with forms to complete. There was no doubt about who they were and that they had been impacted on. It is an issue of trust. No indications were given as to how long it would take or how much women could expect to receive. It was not a question of looking at a big payout. They were concerned about spending money they did not have on diagnostics. That was the key issue.

In September 2018 a woman was contacted about a test audit. She was told that the process would take six months to complete. In July 2019, ten months after she had started the process, she was informed that she could expect to receive a communication one month in advance of the results, but she heard no more until last month, 12 months after she had commenced the process, when she rang to request her results. As of last week, she had still heard nothing. She phoned again last Friday only to be told that somebody would contact her on Monday but nobody did. When she contacted them again today, she was told that it would be another four to six weeks. In all, it will have taken 15 months - 15 months of worry.

An apology is really important. I want not to diminish but acknowledge it. However, unless it changes how the women are still being treated, there is a question mark over it.

I pay tribute to Dr. Scally who gave priority to the victims. He wanted to give them a loud voice and get to the truth. We all acknowledge that he has done very good work. He has spoken about the obstacles he encountered, especially in gaining access to senior officials in the Department of Health and the HSE. That was subsequently rectified, but it should not have happened. He outlined how much of their time had been used in attending and preparing for various Oireachtas committee meetings. We all need to reflect on how we conducted ourselves in dealing with this debacle. We need to ask if we impeded or helped. This acknowledgement must consider these things.

There would be no apology today without Vicky Phelan. Members of the 221+ group, many of whom are in the Visitors Gallery, would have been suffering in silence and would not know each other had it not been for Vicky Phelan who had the courage to bring this issue into the public domain. While she was a very ill woman, she had the courage to say she would not sign a non-disclosure agreement, understanding what that meant. Others then realised they were not suffering alone and the bigger scandal was brought into full view.

I particularly remember Emma Mhic Mhathúna who went to primary school with my children. I remember her as a child. She left this world worrying whether her children would remember her. I hope they will hear today's apology for her.

For those who were so badly affected by this, the very least they should be sure about is that when they are giving their imprimatur, it means what it should mean, that is, it is as safe as it possibly can be. Some have encouraged other women to have screening tests because they are incredibly important. That has to be the legacy of this.

Minister for Health (Deputy Simon Harris)

I want to close today's statements by sincerely thanking the women and family members who are here with us in the Gallery, those who are watching proceedings nearby and those who are watching from afar. I have met many of you over the past year and a half and come to know some of you very well. Others I may know less well but I hold their personal stories and experiences with me each and every day. These experiences they have shared with us have been incredibly impactful and there is no doubt but that they have led us to this moment where the Taoiseach has apologised on behalf of our State. I acknowledge that today is an important day but a very difficult day. I acknowledge that such an apology cannot undo all that has happened, certainly not, but something that really stayed with me from the Scally report was his finding that many women and families wanted someone who was involved to say sorry and to mean it. I hope all those affected, whether they are here in the Oireachtas or watching from home, can finish this day in no doubt that the State apology offered to them is genuine. I hope it brings some healing, which I know is rightly so important to them and the 221+ representative group. It is one thing to stand here and apologise for others, it is easy for me to apologise for others. I want to personally apologise to the women affected as well. I apologise for the times that I gave commitments that were heartfelt and genuine and were harder to follow through on. I apologise for the times we have had to come into this House and give partial information because that was all we had available and for the hurt that caused. I personally apologise. The words of Deputy Catherine Murphy are honest and raw and challenging, in that we need to learn lessons from this as well. I certainly commit to doing that.

It is said we do not heal in isolation but in community. These women have provided a community of support to one another through all of this and in this moment, today in Dáil Éireann, their country, their State, joins with them. We have come to learn a lot about the reality of cervical cancer and the devastation it wreaks on women and their families. We came to know women and men who became household names, though that was never their desire. They gave up their privacy and let us into intimate details of their lives in order that their experiences would become ours; women who have survived but whose bodies, psyche, self-image and future will never be the same again. When I think back on those late April days of last year, when all that we have been discussing this afternoon was still unfolding, I remember making a decision to contact Vicky Phelan, who is here with us today, directly. That would be the first chat of many we would go on to have but it was indeed the most important conversation I have had in all of this. Vicky's words that day were typical of her determination and generosity of spirit when she said to me, "Simon, I just want some good to come out of this." Those words not only stayed with me but guided me from then on. There are many things we wish had not happened throughout this crisis but there is one outcome we can never regret. We now have a national goal of effectively eradicating this horrific cancer. We can move towards a future where as few women as possible experience the awful reality of a cervical cancer diagnosis.

We know how to do this. We can achieve this through an effective HPV vaccination programme combined with a well-organised screening programme. This year, as others have said, we extended the HPV vaccination programme to boys as well as girls. I think of Laura Brennan this afternoon as well. This is a significant step towards protecting the future health of our children from the most serious consequences of HPV infection. Our efforts to increase vaccination uptake rates will continue to intensify. We will keep pushing back against the misinformation because this is a vaccine that saves lives and we will build on the improvements we have seen in recent years. Work is progressing well on the introduction of HPV primary screening during the first quarter of next year. I join others who say we must work collaboratively and collectively to make this happen. This is the culmination of a lot of hard work and will make Ireland one of the first countries to introduce this method of testing. We are investing in the Coombe to develop our own national cervical screening laboratory so we never again will be so reliant on other people's laboratories and, in line with Dr. Scally's recommendation, we have established our first ever national screening committee. We are not just saying sorry. We are implementing every single one of Dr. Scally's recommendations. All of us are involved. There is no disunity on that. We have re-established the women's health task force. We have put patient advocates on the HSE board and we have told Dr. Scally not to just do his report and go away but to hold our feet to the fire and make sure we deliver this and he is doing a superb job in that regard.

I wish to acknowledge the intense work of many people across the health service who are working hard to make this a reality. I too want to emphasise, as I know our patient advocates do, the substantial contribution of the CervicalCheck staff and the work they have done to contribute to women's health over the ten years of the programme. We must do everything we can to ensure that we have a cervical screening programme that women can trust. I acknowledge the active contribution that so many are making, particularly Stephen Teap and Lorraine Walsh, to the work under way in my Department and the HSE in that regard. Today is a difficult day but it is also a significant one. It is the day we formally say sorry but it is also the day we say collectively we can, we must and we will do better. Some good must come from this. The CervicalCheck crisis has left a very painful mark on very many but we must ensure that it leaves a legacy. Our legacy to the next generation does not stop at making sure the mistakes made here are not repeated. Our legacy is a country that protects our people from this awful disease. I reiterate my apology, my support for the Taoiseach's words and my sincere thanks to the women and families who are here with us today. I promise them that I will continue to work to achieve the goals that I know we in this House and beyond, across the Oireachtas, share to eradicate this horrific disease and to stand by the women who have been affected.